I just can't resist wading in to this one...

I think Jacquie's note that people are their own agents is a crucial one.
BUT that should prompt us to acknowledge their role (and our own) as agents
for political change. Shouldn't our programming (including our health
promotion programming) make that front and centre? Why do so many 'health
promotion' materials, intended to educate the communities we work with, not
even mention that poverty (and pollution, and unhealthy working
conditions..) are the primary determinants of health? If it's supposed to be
a secret, it's not a very well kept one.

Here's an illustration from my own recent experience. I worked on a project
a while back looking at heart health issues for multicultural communities.
We did a literature review, some key informant interviews, and some focus
groups with people from different ethnocultural communities in Toronto.

Everything we read from the literature, and everybody we interviewed pointed
to poverty, stress, isolation, etc as the central culprit in poor heart
health.

The focus groups were fascinating: their level of knowledge about 'good' vs
'bad' food was quite high. In fact, I was surprised at how frequently people
expressed anxiety about contaminants and additives in food. (Not a concept
the heart health literature had acknowledged).

They knew about smoking. They knew about exercise. (One woman left me
speechless when she asked why the pamphlets suggested a daily walk when the
radio was warning people to stay inside because of smog. I wished I had the
power to hire her as a health promotion educator.)

But what they really wanted to talk about was the stress in their lives. Did
I understand, they wanted to know, how little time they had for shopping and
cooking? Did I understand that after a 12 hour taxi shift they didn't really
feel like a jog? Did I understand that their kids were in danger of dropping
out of school because the new curriculum was so daunting? That gulping a Big
Mac down at lunch was really, really, really the least of their worries?

They told us all of this with humour, patience and remarkable generousity of
spirit. I wanted to let them know that, yes, I understood. And that the
great group of health promoters and public health folks I was working with
understood. (They really did - the group I was working with worked with
disadvantaged people every day, and they understood the determinants of
health with a passion).

And then I looked at the heart health brochures. Eat your vegetables, quit
smoking and go for a walk. Or it's your fault. Not a word about the primary
causes of heart disease that everybody - the researchers, the health
promoters, the service providers, the people in our focus groups;
everybody! - knew about. I wondered if this didn't border on contempt.

The person who first started this exchange, so many emails ago, asked about
community capacity. I wonder if part of building capacity is building
awareness (or, more accurately, validating the awareness they already have)
that social conditions are the biggest keys to health and that communities
can mobilize to affect those social conditions. That doesn't preclude
messages about individual behaviour change, but I think it should preceed
them.

Glen Brown

Glen Brown & Associates Consulting
488 Parliament Street, #1
Toronto Ontario M4X 1P2
T: 416-892-2286
F: 416-966-1362
E: [log in to unmask]


-----Original Message-----
From: Health Promotion on the Internet [mailto:[log in to unmask]]On
Behalf Of Jacquie Poitras
Sent: January 8, 2003 4:36 PM
To: [log in to unmask]
Subject: Re: community capcity for healthy eating


I recognize that health and healthy eating have many social determinants.
Every choice we make is based, in part, on societal factors, dis/advanatage,
peer group, consumerism--you name it.  But in the end, it is us as
individuals
who make decisions about our lives.  We are agents who act in a manner to
improve our health or who choose "unhealthy" options.

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